Education

High School or GED equivalent.

Experience

Three years' medical billing, collection and account resolution experience. Previous nursing home room and board billing desired

Knowledge, Skills and Abilities

• Thorough knowledge and understanding of medical billing, insurance and private pay.
• Strong knowledge of all medical billing requirements for Medicare, CareFirst, Medical Assistance, Commercial insurance, and HMO carriers
• Strong collection skills, including claims follow-up and revenue cycle practices.
• Builds a good rapport with nursing facilities.
• Ability to multi-task, set priorities, and manage time effectively.
• Exemplary computer skills, including EMR knowledge and Microsoft Office including excel.
• Attention to detail and strong math skills.
• Skill in data analysis and interpretation Strong interpersonal skills

Physical Requirements

• Ability to sit, concentrate and pay close attention to detail

Working Conditions

• Normal office environment with little exposure to excessive noise, dust, temperatures and the like

Principal Duties and Responsibilities

• Manages assigned nursing home's claims processing functions,from eligibility through claim resolution, including adjusting claims.
• Manages large account spreadsheets, communicates with nursing home partners.
• Performs all inpatient room and board billing.
• Collaborate with business development managers ongoing.
• Balancing claims to ensure payments from Medicaid are appropriate
• Ensures all payments to nursing facilities are valid.
• Manages assigned Epic work queues daily to ensure accurate billing and expedient claims follow-up.
• Process any late charge claims, claims resubmission and/or claim corrections to payors.
• Submit all claim files to Medicaid and other payers. Including but not limited to file transfer of payment files.
• Responds to patient and third party payor inquiries regarding patient accounts via e-mail, telephone, mail, and in person.
• Troubleshoot any claim discrepancies to resolution.

All roles must demonstrate GBMC Values:

Respect

I will treat everyone with courtesy. I will foster a healing environment.

• Treats others with fairness, kindness, and respect for personal dignity and privacy

• Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

• Meets and/or exceeds customer expectations

• Actively pursues learning and self-development

• Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

• Sets a positive, professional example for others

• Takes ownership of problems and does what is needed to solve them

• Appropriately plans and utilizes required resources for various job duties

• Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

• Works cooperatively and collaboratively with others for the success of the team

• Addresses and resolves conflict in a positive way

• Seeks out the ideas of others to reach the best solutions

• Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

• Demonstrates honesty, integrity and good judgment

• Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

• Embraces change and improvement in the work environment

• Continuously seeks to improve the quality of products/services

• Displays flexibility in dealing with new situations or obstacles

• Achieves results on time by focusing on priorities and manages time efficiently

COVID-19 Vaccination

All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.